We’ve all felt it-the nagging ache in the neck after a long case, the persistent wrist pain that creeps in after hours of drillingor the fatigue that sets in before the final suture. Yet, we rarely talk about the toll surgery takes on our own bodies. Orthopaedic surgeons pride themselves on resilience, but ignoring ergonomics is a slow march toward becoming the patient. This isn’t just about comfort; it’s about preserving our careers and maintaining surgical excellence.
Traditionally, surgical training has emphasized technical skill and decision-making, with little attention paid to the physical demands of the OR. The prevailing mindset treated discomfort as a rite of passage, a badge of honor. But emerging evidence paints a different picture. Musculoskeletal disorders (MSDs) affect up to 80% of surgeons at some point, with spine, shoulderand wrist injuries leading the charge. These aren’t trivial complaints-they contribute to burnout, reduced operative efficiencyand even early retirement. The noise of “tough it out” is fading, replaced by a signal that demands we rethink how we position ourselves during surgery.
Let’s dissect the fundamentals. First, posture matters more than we admit. The classic “head down, shoulders hunched” stance is a recipe for cervical strain and chronic pain. Studies using motion capture and electromyography reveal that surgeons who maintain a neutral spine and avoid excessive forward flexion experience less fatigue and fewer MSDs. This challenges the old habit of leaning aggressively into the field for better visualization. Instead, we must leverage adjustable OR tables, ergonomic stoolsand surgical loupes with proper declination angles to keep our necks aligned.
Second, instrument design and handling are not just ergonomic luxuries-they are surgical necessities. Traditional instruments often require awkward wrist angles and excessive grip force, compounding strain over time. Innovations in handle design, weight distributionand even powered tools can reduce the load on small joints. But the art lies in selecting tools that fit our hands and adapting our technique accordingly. This is where mentorship and self-awareness intersect: recognizing when an instrument is working against us rather than for us.
Third, microbreaks and intraoperative movement are underutilized strategies. The culture of uninterrupted focus discourages pauses, yet brief, intentional stretches during long cases can reset muscle tension and improve circulation. Incorporating these microbreaks requires a shift in mindset and OR culture-something that must start with leadership. We owe it to ourselves and our teams to model sustainable practices that preserve stamina and precision.
What does this mean for the surgical fundamentals we were taught? It means that technical mastery alone is insufficient. Surgical excellence now demands physical sustainability. We must integrate ergonomic principles into our daily practice, from residency onward. This includes proactive education on body mechanics, investing in ergonomic equipmentand fostering an environment where surgeons can speak openly about physical strain without stigma.
Our take is clear but nuanced: Ergonomics is not a luxury or an afterthought-it is a critical component of surgical professionalism. We cannot compartmentalize our bodies as mere vessels for skill; they are active participants in every procedure. By prioritizing ergonomics, we extend our careers, enhance our performanceand ultimately improve patient outcomes. The challenge lies in overcoming entrenched cultural norms and embracing a holistic view of surgical health.
For the learner, the takeaway is straightforward: start with awareness. Observe your posture, evaluate your instrumentsand advocate for ergonomic resources. Encourage your mentors and peers to do the same. The OR should not be a battleground where we sacrifice our bodies for the sake of the case. Instead, it should be a space where surgical artistry and physical well-being coexist. After all, the best surgeon is one who can operate not just brilliantly, but sustainably.
